Z13.820 Insurance Policy Changes

ICD-10 Z13.820 is officially defined as "Encounter for screening for osteoporosis." code Z13.820 is referenced in 6 tracked payer policy changes from Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code Z13.820 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Aug 20, 2026High impact
Bone Densitometry/Bone Density Studies 6.01.05
Effective August 20, 2026, VFA with DEXA and TBS was removed from the list of investigational screening procedures, and DEXA can be completed with or without VFA or TBS. BMD testing is considered medically necessary when one of the listed methods is used, including DEXA, and one of the listed indications is met. Follow-up BMD testing is considered medically appropriate every two years, when at least 23 months have passed since the month of the last test, and testing every three years is recommended after starting bisphosphonate therapy.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2026Medium impact
Bone Mineral Density Studies
Bone density measurements are covered once per lifetime for general osteoporosis screening for women beginning at age 65 under the Healthy You! Wellness benefit, and screening is limited to the hips or spine using DEXA. An initial hip or spine measurement may be considered medically necessary for women age 65 and older, men age 70 and older, and others at risk of osteoporosis, and repeat measurements may be considered not more often than every 5 years for at-risk individuals who previously tested normal. The 10/01/2026 update added ICD-10 codes K74.0A, K76.83, Z68.18 and Z68.19, and Z68.1 was deleted as of 09/30/2026.
Aetna · Identified Sep 29, 2026Medium impact
Biochemical Markers of Bone Remodeling (CPB 0562, reviewed 2026-08-21)
Aetna considers measurements of bone turnover markers for evaluating fracture risk experimental, investigational, or unproven, including bone sialoprotein, cathepsin K, osteocalcin, osteoprotegerin, P1NP, RANKL, sclerostin, and CTX-1 and NTX-1 telopeptides. Aetna also considers plasma homocysteine for evaluating fracture risk, plasma leptin for osteoporosis screening, and serum or urinary collagen crosslinks or other bone remodeling markers for the screening, diagnosis, or management of osteoporosis experimental, investigational, or unproven. Measurement of bone-specific alkaline phosphatase as a diagnostic marker for children and adolescents with secondary osteoporosis, bone turnover markers for persons receiving serotonergic anti-depressants, and collagen crosslinks for bisphosphonate-induced jaw osteonecrosis, chronic kidney disease, or osteogenesis imperfecta are also experimental, investigational, or unproven.
Aetna · Identified Aug 19, 2026Medium impact
Bone Mass Measurements (CPB 0134, reviewed 2026-03-19)
Aetna considers bone mass measurement medically necessary when a member meets one of the listed criteria, such as long-term glucocorticoid therapy of 5 mg prednisone or more per day for more than 3 months, long-term anticonvulsant therapy, long-term aromatase inhibitor therapy, or non-traumatic (fragility) fractures. Repeat bone mass measurements are usually not indicated more frequently than once every 2 years, except in the circumstances the policy lists. Bone mass measurement by dual photon absorptiometry, dual X-ray and laser, single photon absorptiometry, pulse-echo ultrasound, cone beam CT, deep learning-based quantitative CT, finite element analysis, skin autofluorescence for AGEs, radiofrequency echographic multi spectrometry and urinary phthalate testing is considered experimental, investigational or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Musculoskeletal Assessment Systems (CPB 0212, reviewed 2026-03-25)
Aetna considers the Metrecom skeletal analysis system and other computerized, biomechanical or digital skeletal analysis systems experimental, investigational or unproven, because the value of their analysis in improving clinical outcomes is unproven, and the same applies to their individual components. The FIGUR8 Advanced Musculoskeletal Assessment System is also considered experimental, investigational or unproven for neuromuscular control screenings for injury prevention and rehabilitation, and there is a lack of peer-reviewed evidence for its clinical value. CPT codes 0778T, 95851 and 97750 are listed as not covered for the indications in the policy, as are the listed ICD-10 codes, including M00.00 through M99.9, S00.00xA through T14.91, and Z13.820 through Z13.858.
Aetna · Identified Aug 12, 2026Medium impact
Biochemical Markers of Bone Remodeling (CPB 0562, reviewed 2025-08-22)
Aetna considers measurement of bone turnover markers for evaluating fracture risk experimental, investigational, or unproven because their clinical value for this indication has not been established. The markers listed include bone sialoprotein, cathepsin K, osteocalcin, P1NP, CTX, sclerostin, osteoprotegerin, and RANKL. Aetna also considers experimental, investigational, or unproven the measurement of biochemical markers for diagnosis and monitoring of aseptic loosening or osteolysis in total joint arthroplasty, for osteoporosis screening, diagnosis, or management, plasma homocysteine for fracture risk, plasma leptin for osteoporosis screening, and serum microRNAs.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code Z13.820?

There are 6 tracked policy changes affecting code Z13.820, including updates from Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z13.820?

Payers that have issued tracked updates for code Z13.820 include: Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code Z13.820 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z13.820. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code Z13.820?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Bone Densitometry/Bone Density Studies 6.01.05

Bone Mineral Density Studies

Biochemical Markers of Bone Remodeling (CPB 0562, reviewed 2026-08-21)

Bone Mass Measurements (CPB 0134, reviewed 2026-03-19)

Musculoskeletal Assessment Systems (CPB 0212, reviewed 2026-03-25)

Biochemical Markers of Bone Remodeling (CPB 0562, reviewed 2025-08-22)

What insurance policy changes affect code Z13.820?

Which payers have updated policy for code Z13.820?

How do I get notified when code Z13.820 policy changes?

Why do payers change policies for code Z13.820?